AB0279 HERPES ZOSTER IN RHEUMATOID ARTHRITIS. PROSPECTIVE SINGLE UNIVERSITY CENTER STUDY
Authors: L. C. Domínguez-Casas, P. Rodriguez Cundin, T. Dierssen-Sotos, N. Vegas-Revenga, A. Corrales, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with Rheumatoid arthritis (RA) have an increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The risk of herpes zoster (HZ) including disseminated HZ is also increased (1 ) Objectives In an unselected series of RA patientswe assess a )prevalence, b )general features and c ) predictive factors of HZ. Methods Study of 393 RA patients included in the prospective vaccination program of the Preventive Medicine and Rheumatology department of a University hospital, from October 2011 to October 2016. The minimum follow-up was of 12 months; therefore, it was made until December 2020. HZ vaccination is not included in our vaccination program. RA was diagnosed according to the ACR/EULAR 2010 criteria. HZ was diagnosed if presented: characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized). Information on patients and HZ characteristics was retrieved from the hospital and general physician records. Results We studied 393 patients (310 women), mean age 61.5±11.9 years. They were followed-up during a mean period of 82.6±15.2 months(range; 50 months-9 years). HZ infection was observed in 31 of 393 patients (7.9%) (26 women); mean age 67.5±11.6ys. Prevalence of HZ in this period (122months) was 7.88% with an annual incidence rate of 0.73/100 patients/year. A comparison between patients with and without HZ was performed (Table 1 ). Table 1. Main features of different groups Variables RA patientsN= 393 RA with HZN=31 RA without HZN=362 PHZ vs noHZ Variables (continued) RA patientsN= 393 RA with HZN=31 RA without HZN=362 PHZ vs noHZ Age (years) (men±SD) 59.4±12.9 64.7±11.8 59.1±12.9 0.02 MTX 365 (92.87) 29 (93.54) 336 (92.81) 0.87 Sex (women)(%) 309(78.62) 25 (80.6) 284 (78.5) 0.95 LFN 127 (32.31) 12 (38.70) 115 (31.76) 0.42 RA Evolution(months) (mean±SD) 136.9±109.8 155.3±117.0 135.30±109.2 0.33 SSZ 94 (23.91) 7 (22.58) 87 (24.03) 0.78 Hypertension, n(%) 165 (42.0) 19 (61.3) 146 (40.3) 0.04 Anti-TNFa, n (%) Diabetes Mellitus, n(%) 55 (14.0) 7 (22.6) 48 (13.3) 0.24 ADA 144 (36.6) 15 (48.4) 129 (35.6) 0.22 Dislypidemia, n(%) 149 (37.9) 15 (48.4) 134 (37.0) 0.29 ETN 139(35.4) 16 (51.6) 123 (33.9) 0.05 RAfeatures, n(%) IFX 40 (10.1) 5 (16.1) 35 (9.7) 0.25 PositiveRF 224 (57.0) 17 (54.8) 207 (57.2) 0.95 GLM 33 (8.4) 3 (9.7) 30 (8.3) 0.74 PositiveACPA 207 (52.7) 13 (41.9) 194 (53.6) 0.29 CZP 13 (3.3) 1 (3.2) 12 (3.3) 0.97 Erosions 145 (36.9) 10 (32.3) 135 (37.3) 0.71 Non anti-TNFa n (%) Subcutaneousnodules 22 (5.6) 1 (4.6) 21 (5.8) 0.85 TCZ 134 (34.1) 16 (51.6) 118 (32.6) 0.05 Pulmonary fibrosis 20 (5.1) 3 (9.7) 17 (4.7) 0.20 RTX 69 (17.5) 9 (29.0) 60 (16.7) 0.13 Associated Sjögren Syndrome 20 (5.1) 1 (3.2) 19 (5.3) 0.95 ABA 55 (13.9) 6 (19.3) 49 (13.5) 0.41 Vasculitis 23 (5.9) 2 (6.5) 21 (5.8) 0.7 SARI 2 (5.1) 1 (3.2) 1 (0.3) 0.03 RATreatment, n (%) JAK inhibitors n (%) Prednisone 139 (35.4) 19 (61.3) 120 (33.1) 0.04 BARI 32 (8.14) 3 (9.67) 29 (8.01) 0.73 Prednisona&gt;5mg/d 13 (3.30) 5 (16.1) 8 (2.20) 0.001 TOFA 17 (4.32) 3 (9.67) 14 (3.87) 0.14 ConventionalDMARDs UPA 4 (1.01) 1 (3.22) 3 (0.83) 0.20 HZ locations were intercostal (n=6), dorsal (5), abdominal (3), lumbar (3), facial (3), cervical (1), gluteus (1), submmamary fold (1), intermmamary fold (1) and upper extremity (1). Main HZ complications were post-herpetic neuralgia (n=7), visual alteration in facial HZ (n=1) and disseminated HZ(n=1). HZ treatment was anitiviral agents (n=23) (brivudine=7; acyclovir 6; famciclovir6; valaciclovir4), topic (n=2) and none (n=6). Predictive factors for HZ(Figure 1) were older age (&gt;65 years), hypertension and treatment with high prednisone dose and antiTNF. Figure 1. Predictive factors for Herpes zoster Conclusion HZ is a relative frequent complication of RA. In our series, although are usually localized, post-herpetic neuralgia is relatively frequent. Probably to include HZ vaccine in our vaccination program of RA may be useful. References [1]Robert Harrington et al., J Inflamm Res, 2020 14;13:519-531 Disclosure of Interests None declared